{"id":"daf7bd89f52e","type":"article","url":"https://hartvaat.nl/2018/05/01/farmacogenomisch-gestuurd-antiplaatjestherapie-bij-acs-pharmclo-trial/","title":"Farmacogenomisch gestuurd antiplaatjestherapie bij ACS: PHARMCLO-trial","title_en":"Pharmacogenomic Approach to Selecting Antiplatelet Therapy in Patients With Acute Coronary Syndromes: The PHARMCLO Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.02.029","source_url":"https://doi.org/10.1016/j.jacc.2018.02.029","authors":["Francesca Maria Notarangelo","Giuseppe Maglietta","Paola Bevilacqua","Marco Cereda","Piera Angelica Merlini","Giovanni Quinto Villani","Paolo Moruzzi","Giampiero Patrizi","Guidantonio Malagoli Tagliazucchi","Antonio Crocamo","Angela Guidorossi","Filippo Pigazzani","Elisa Nicosia","Giorgia Paoli","Marco Bianchessi","Mario Angelo Comelli","Caterina Caminiti","Diego Ardissino"],"significance":7,"published":"2018-05-01","source_date":"2018-05-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/secundaire-preventie-na-acs/"],"congress":"","summary_en":"The PHARMCLO trial of pharmacogenomic-guided antiplatelet selection in ACS was among the first to show that genotype-directed therapy reduces ischemic events, pioneering the application of pharmacogenomics in acute coronary care.","created":"2026-07-03T10:27:16Z","updated":"2026-07-03T13:26:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PHARMCLO gerandomiseerde trial naar farmacogenomisch gestuurd antiplaatjesbeleid bij ACS. Pionierswerk in genetica-geleide therapiekeuze voor P2Y12-remmers.","abstract_original":"BACKGROUND: Although clopidogrel is still frequently used in patients with acute coronary syndromes (ACS), its efficacy is hampered by interpatient response variability caused by genetic polymorphisms associated with clopidogrel's metabolism. OBJECTIVES: The goal of this study was to evaluate whether selecting antiplatelet therapy (clopidogrel, prasugrel, or ticagrelor) on the basis of a patient's genetic and clinical characteristics leads to better clinical outcomes compared with the standard of care, which bases the selection on clinical characteristics alone. METHODS: Patients hospitalized for ACS were randomly assigned to standard of care or the pharmacogenomic arm, which included the genotyping of ABCB1, CYP2C19*2, and CYP2C19*17 using an ST Q3 system that provides data within 70 min at each patient's bedside. The patients were followed up for 12 ± 1 month for the primary composite endpoint of cardiovascular death and the first occurrence of nonfatal myocardial infarction, nonfatal stroke, and major bleeding defined according to Bleeding Academic Research Consortium type 3 to 5 criteria. RESULTS: After enrolling 888 patients, the study was prematurely stopped. Clopidogrel was used more frequently in the standard-of-care arm (50.7% vs. 43.3%), ticagrelor in the pharmacogenomic arm (42.6% vs. 32.7%; p = 0.02), and prasugrel was equally used in both arms. The primary endpoint occurred in 71 patients (15.9%) in the pharmacogenomic arm and in 114 (25.9%) in the standard-of-care arm (hazard ratio: 0.58; 95% confidence interval: 0.43 to 0.78; p < 0.001). CONCLUSIONS: A personalized approach to selecting antiplatelet therapy for patients with ACS may reduce ischemic and bleeding events. (Pharmacogenetics of Clopidogrel in Patients With Acute Coronary Syndromes [PHARMCLO]; NCT03347435)."}